Abstract

Introduction: Post-thyroidectomy neck hematoma is one of the most feared and dangerous complications in thyroid surgery leading to airway obstruction and, if diagnosed and treated too late, fatal outcome may result. For prevention most crucial is effective intraoperative hemostasis. Additionally the patient should avoid physical strain. In case of post-thyroidectomy acute bleeding immediate airway protection is essential. Sometimes even bedside evacuation of hematoma is live saving. Neck hematoma more than 24 hours after thyroid surgery, as in our case, is rare.
Case Report: In a 56-year old female, 10 days after hemithyroidectomy and ipsilateral parathyroidectomy on the right side a post surgical neck hematoma arose. At that time the patient stayed in our region on holiday for skiing in a mountain skiresort about 100 km away from our clinic. Emergency doctor on site did not intubate her and took her to our medical university hospital, although the next hospital would have been 25 km closer. On arrival the patient was already hard breathing, unable to speak and swallow. Immediate intubation via videolaryngoscopy by an experienced senior anaesthesiologist succeeded. Due to major edema of the upper airway the patient had to be remained intubated for 3 days after reoperation. Seven days after the event the patient could be discharged from hospital.
Conclusion: Post-thyroidectomy neck hematoma more than 24 hours after surgery is rare. Misinterpretation of the life-threatening situation may lead to major complications as apallic syndrome or even death. Immediate protection of the airway by intubation is essential.